Minimally Invasive Lumbar Laminectomy

A laminectomy can be performed on all regions (lumbar, thoracic, cervical) of the spinal column to relieve pressure on the spinal cord or the nerve roots. The lamina is the bony roof of the spinal canal. Laminectomy is the term used to refer to the process of removing the lamina (usually both sides). Removing the lamina increases the size of the spinal canal, giving more room for the spinal cord or nerve roots.

This procedure is also called a spinal decompression. Pressure on the nerve roots or the spinal cord can be caused by bony spurs or by a herniated or bulging disc. This pressure is often referred to as spinal stenosis and can cause pain and weakness. Removing the lamina as well as any other sources of compression such as bone spurs, a herniated disc, or disc bulges relieves the pressure. Decompression of the nerve roots and the spinal cord relieves pain and other symptoms. Refer to the section Lumbar Stenosis for further information.

Pathology

With advancing age, several changes occur in the bone, disk, joints and ligaments of the lumbar spine.

Surgery

Minimally invasive laminectomy is a surgical approach to lumbar stenosis using smaller incisions to widen the boney canals around the spinal nerves.

The minimally invasive laminectomy is an exciting new treatment option for patients who are candidates for the surgical treatment of lumbar spinal stenosis. Overall when compared to traditional open procedures, the minimally invasive technique offers the attractive benefits of far less disruption of normal tissue, faster surgical time, decreased post-operative discomfort, quicker recovery time, and a typically more rapid return to normal activity.

A 1-inch incision is made.

Using a set of tapered metal dilators passed over the guiding needle, the tissue and muscles are then gently spread apart.

A hollow metal cylinder is then passed down to the area of the stenosis and secured.

Through this working channel, an operating microscope is then used to provide your surgeon with a close-up, magnified view of the problem.

With this close-up operative view, your surgeon can then microsurgically remove the bone compressing the nerve roots thereby relieving the stenosis. Through the same incision, the surgeon can swing the working channel to decompress the level immediately above and below as well.

Post-operatively, patients are in the hospital for one to two days, and the individual patient’s mobilization (return to normal activity) is largely dependent on his/her pre-operative condition and age. Directly following the procedure, patients are encouraged to walk. However, it is recommended that patients avoid excessive bending, lifting or twisting for six weeks in order to avoid pulling on the suture line before it heals.

The success rate of a laminectomy surgery is favorable. After healing, approximately 75% to 80% of patients will have significant improvement in their function (ability to perform normal daily activities) and markedly reduced level of pain and discomfort. The surgical results are much better for relief of leg pain caused by spinal stenosis, and not nearly as reliable for relief of lower back pain alone.

Risks and Possible Complications

While decompressive laminectomy is a relatively safe procedure, and despite even the greatest care, complications do occur;

• Hemorrhage. Hemorrhage may cause compression of the nerve roots with resulting weakness or paralysis in the legs, loss of feeling and loss of bowel or bladder control
• Tearing of the dura over the nerve roots. This problem occurs because the ligaments may be stuck to the dura, and can lead to injury to the nerve roots, pain, and leakage of cerebrospinal fluid (the fluid that surrounds the nerve roots). If leakage occurs, this must be corrected to prevent later infection
• Infection of the wound
• Direct injury to the nerve roots causing weakness or paralysis in the legs, loss of feeling and loss of bowel or bladder control. Tears in the dura and injury to the nerve roots are minimized by the use of magnification at the time of surgery
• Deep venous thrombosis with pulmonary embolism. This is a very serious problem. In some patients, blood clots will form in the veins of the legs or pelvis. These clots may come loose from the vein wall and travel to the lungs causing severe difficulty with respiration and even death
• Since this surgery is most often performed on an older population, the patient may also be subject to complications related to heart or lung disease, diabetes, or hypertension

See the section on Risks and Possible Complications for further information.

After Surgery

Pain: The leg or buttock pain that you experienced prior to surgery should begin to diminish shortly after surgery. However, it is not unusual for some degree of this pain to linger for quite some time, especially if you had the pain for a long time prior to the surgery.

Some patients experience nerve swelling 2-4 days after their surgery. This can cause recurrence of the leg pain that was experienced prior to surgery. Once the swelling diminishes, the pain will begin to go away. By 4-6 weeks, the incision pain is mostly gone. A back and abdominal strengthening program are started in physical therapy at 3 - 4 weeks. Return to work will be determined on an individual basis.

Numbness and Weakness: If you experienced numbness and/or weakness in your foot or leg prior to surgery, it may not change much immediately after surgery. This will depend greatly on the extent of nerve damage that resulted from the nerve compression. For some patients, recovery of the nerve can take up to several months. For others the nerve may have been so severely damaged that recovery is not possible. Nerve recovery is very unpredictable and is dependent on many factors - all of which are individual to each patient.

Activity Level: We expect you to get out of bed as soon as possible, no later than the morning after surgery. We ask that you alternate walking and lying down several times throughout the day minimizing sitting, as this will aggravate back spasms. Immediately after surgery, walking is the best exercise. This should involve slow progressions in distance and frequency. Always rest between the walks. Some patients are also able to begin walking programs in a swimming pool. This, however, is not advisable until 2 weeks after surgery.

Do not lift anything over 10 lbs. until we have decided otherwise.

Driving: Do not drive until we’ve discussed it in a follow-up visit, or you are 3 weeks out from surgery. Before driving can safely be resumed, a practice session in a parking lot is needed to be certain that the patient can get from the accelerator pedal to the brake quickly enough for safe driving.

Sex: You may carefully engage in sexual activity 3 weeks after surgery.

Please walk as much as is comfortable. Short distances are better than long. Do not spend the day in bed. Even when you are lying down, you should exercise your legs frequently. For more detailed instruction, see the pamphlet entitled Going Home After Lumbar Laminectomy.

Generally, lumbar spine surgery is safe and very effective in properly selected patients. However, both the doctor and the patient must participate fully to get the best possible result.

Office Hours

Our office hours are Monday through Friday from 8:30 AM to 4:30 PM. We ask that you call between these hours with your questions, concerns, prescription refill requests, etc. As a surgeon, I am frequently in the operating room and therefore unable to be available during all office hours.

Prescriptions

All prescription refills and changes must be requested during office hours. We advise patients to monitor their need for refills so that refill requests can be made during your office visit.

Emergencies

We understand that emergencies arise. If you feel that it is absolutely necessary to speak with your doctor during non-office hours, our answering service is available, by simply dialing our office telephone number listed below. We ask that this service be reserved only for emergencies.

Office Phone 580-531-4600